Since the first humans began to investigate ways to treat their injuries and ailments, some form of an instrument with which to take a closer look at what’s going on inside the body has been a holy grail among physicians and surgeons. Their dreams were realised to a degree when, in 1895, Wilhelm Conrad Röntgen discovered X-rays. However, although the fuzzy, negative images that followed proved valuable, direct viewing of joints such as the shoulder only became possible through arthroscopy.
Even before Röntgen’s discovery, doctors in other medical fields were already using illuminated hollow tubes to peer inside various body cavities. Collectively, these instruments are now known as endoscopes, and there is evidence that an early prototype discovered could date from the time of ancient Greece and Rome. However, it was an instrument developed by Philipp Bozzini in 1805 that is recognised as the defining breakthrough in this field. In time, the German physician’s candle-lit device would inspire more sophisticated instruments capable of a range of minimally-invasive internal examinations, including shoulder arthroscopy.
In addition to providing access via the body’s natural cavities such as the oesophagus, trachea and rectum, endoscopes also offered a means to examine internal organs that would have previously required a large abdominal incision to expose them. Instead, when inserting a suitable endoscope into the abdomen via a tiny “keyhole” incision, laparoscopy provides the surgeon with a minimally-invasive alternative to laparotomy. Considering the relatively rapid development of endoscopy in general, an instrument with which to perform shoulder arthroscopy was a comparative latecomer.
The First Arthroscope
Despite the successful use of endoscopic examination in most medical fields, it is surprising that this technology was adapted to examine the interior of a joint only in 1918. A Japanese professor named Kenji Takagi modified a cystoscope, customarily used for bladder examinations, to inspect the knee joint of a cadaver. He went on to perfect his instrument and, in 1936, produced the first colour photograph of the interior structure of a knee. Successive improvements have meant that shoulder arthroscopy and the internal examination of most other joints have since become routine orthopaedic procedures.
Modern instruments are no longer simple, hollow tubes but contain optical fibres that transmit light from an LED and pictures of the joint to a miniature video camera. The setup allows the surgeon to view magnified, full-colour images on a monitor. The most recent models are capable of high definition imaging,
For diagnostic purposes, hip, knee, and shoulder arthroscopy can provide the orthopaedic specialist with far greater insight into the causes and extent of disease and damage within a joint than radiography alone. In turn, the experience gained from these examinations has led to significant advances in treating those conditions that commonly affect the joints. Such treatments extend to both accidental injuries and disease and range from relatively simple repairs to partial and total joint replacement procedures known as arthroplasty.
As with other endoscopic applications, shoulder arthroscopy has been adapted to perform minimally-invasive procedures that can eliminate the need for open surgery in which the joint must be fully exposed. Typically, arthroscopic examinations are undertaken on out-patients following a local anaesthetic. When used for therapeutic purposes, this approach can also minimise the time spent in the hospital and reduce overall post-operative recovery times.
Some Common Applications
Injuries to the shoulder or humeral glenoid joint are common, and while some respond to pain relief and physiotherapy, others require surgery. Performing shoulder arthroscopy offers a quick and reliable method for determining the underlying cause and extent of the problem and which course of action will prove most appropriate.
Of the conditions that affect this joint, fractures, rotator cuff injuries, and osteoarthritis are the most common. Among younger patients, physical injuries tend to prevail. However, overall, it is the erosion of cartilage due to osteoarthritis that most often requires the more radical step of replacing one or both of its damaged articulating surfaces.
As with hip and knee replacements, shoulder arthroscopy has also been adapted as a minimally-invasive option when performing arthroplasty. More frequently, though, it is the preferred approach when treating an impingement or repairing a torn or otherwise damaged labrum or ligament.
These and other specialised interventions are available from an experienced team of hip, knee, and shoulder surgeons at the Life Wilgers Hospital in Pretoria. The hospital’s orthopaedic unit is widely recognised as a leading domestic and international referral destination.